PATIENTS UNDERSTANDING AND USE OF ADVANCE DIRECTIVES

The Patient Self-Determination Act was implemented in December 1991. B efore and after its implementation, we used a structured interview of 302 randomly selected-patients to determine their awareness, understan ding, and use of advance directives. Implementation of the Act did not have a major effect on these. Although more than 90% of patients were aware of the living will, only about a third selected the correct def inition or the correct circumstances in which it applied, and less tha n 20% of patients had completed one. About a third of patients were aw are of a Durable Power of Attorney for Health Care and chose the corre ct definition, and about half identified the correct circumstances in which it applies; less than 10% had completed such a document. Surpris ingly, patients who said they had completed advance directives did not demonstrate better understanding of these documents. Our results indi cate that many patients, including some who have completed advance dir ectives, do not fully understand them. It may be unwise to regard thes e documents as carefully considered, compelling statements of patients ' preferences. Appropriate responses to our findings include increased public education, revising state statutes to bring them into congruen ce with public perception, and expanding the dialogue between physicia ns and patients.